Provider Demographics
NPI:1043567654
Name:EVERJOY ADULT FAMILY HOME
Entity Type:Organization
Organization Name:EVERJOY ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-210-7373
Mailing Address - Street 1:3813 GROSVENOR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2313
Mailing Address - Country:US
Mailing Address - Phone:216-210-7373
Mailing Address - Fax:216-321-0860
Practice Address - Street 1:3813 GROSVENOR RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44118-2313
Practice Address - Country:US
Practice Address - Phone:216-210-7373
Practice Address - Fax:216-321-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189075343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)